JP4805293B2 - Biological tissue clip device - Google Patents

Description

  The present invention relates to a clip device for a living tissue that is inserted into a body cavity of a living body and grips the living tissue.

  For example, Japanese Patent Application Laid-Open No. 60-103946, Japanese Utility Model Laid-Open No. 62-170010, Japanese Utility Model Laid-Open No. 2-6011 are known as biological tissue clip devices.

  In Japanese Patent Application Laid-Open No. 60-103946, the clip and the operation wire are engaged through a hook provided at the clip base end and a hook provided at the operation wire distal end. A clip fastening ring is fitted on the arm of the clip. The proximal end portion of the clip clamping ring can be engaged with the distal end portion of the operation tube that is inserted into the introduction tube so as to be able to advance and retract. When the clip is ligated, the clip protrudes from the introduction tube and the operation wire is pulled. At this time, the hook provided at the proximal end portion of the clip is stretched, whereby the engagement between the clip and the operation wire is separated, and the clip can be placed in the living tissue.

  In Japanese Utility Model Laid-Open No. 62-170010, the engagement between the clip and the operating wire is performed by a connecting plate provided between a hook provided at the base end of the clip and a hook provided at the distal end of the operating wire. Is done through. As in JP-A-60-103946, during ligation, the clip protrudes from the introduction tube and the operation wire is pulled. At this time, the hook provided at the proximal end portion of the clip is stretched, whereby the engagement between the clip and the operation wire is separated, and the clip can be placed in the living tissue.

In Japanese Utility Model Laid-Open No. 2-6011, the clip and the operation wire are engaged with each other via a hook provided at the tip of the operation wire and the tip of the hook via a connecting member having a hook. As in JP-A-60-103946, during ligation, the clip protrudes from the introduction tube and the operation wire is pulled. At this time, the hook provided at the distal end portion of the connecting plate is stretched, so that the engagement between the clip and the operation wire is separated, and the clip can be placed in the living tissue.
JP 60-103946 A Japanese Utility Model Publication No. 62-170010 Japanese Utility Model Publication No. 2-6011

  As described above, the conventional biological tissue clip device requires an engaging part such as a hook or a connecting member at the engaging portion between the operation wire and the clip. As a result, the number of parts increases and the manufacturing cost increases.

  Also, if you want to keep the second clip in the living tissue after placing the first clip in the living tissue, remove the clip device from the endoscope channel and clip it to the tip of the operation wire. After loading, it must be reinserted into the endoscope channel. At this time, in the conventional clip device described above, since there is an engaging part between the clip and the operation wire, it takes time to load the clip, and it is a very troublesome work.

  The present invention has been made paying attention to the above circumstances, and the object of the present invention is to reduce the number of parts of the engaging portion between the clip and the operation wire by directly engaging the clip and the operation wire, thereby reducing the manufacturing cost. An object of the present invention is to provide a clip device for a living tissue that can reduce the amount of damage and facilitate the mounting operation of the clip at the time of manufacture.

According to the first aspect of the present invention, an introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, and the introduction tube can be loaded. A clip having a holding portion formed by a plurality of arms that are elastically biased in a direction that extends and expands from the portion, and a proximal end portion of the clip provided at a distal end portion of the operation wire A wire loop portion that is directly hooked and engaged without any other engaging parts, and the arm portion, and the arm portion protrudes from the tip of the introduction tube and expands when the arm portion expands. tip and comprising an engaging portion engageable, to loop the wire forming the wire loop section, the base end side to form part of the operating wire located on the proximal side of the wire loop The introduction pipe and the operation are formed to be thinner than the thickness of the wire. The wire loop portion is broken and the engagement with the clip is released by applying a force in the direction of separating the clip and the operation wire to the operation wire by moving the ear relative to each other. It is the clip apparatus of the biological tissue characterized by these.

  According to this invention, since the engagement structure between the clip and the operation wire is simplified and the number of parts can be reduced, the manufacturing cost can be reduced. According to the present invention, since the number of engaging parts of the operation wire and the loop wire can be reduced, the number of parts can be reduced, and the number of assembling steps by joining work such as welding, adhesion, and caulking can be reduced accordingly. Thereby, manufacturing cost can be reduced. Further, since there is no hard portion at the joint portion between the loop wire and the operation wire, flexibility can be maintained, and insertion of the endoscope into the forceps channel can be maintained. Further, even when the angle of the endoscope is applied, since there is no hard portion, the angle of the endoscope can be easily inserted, and the operation wire can be reliably protruded from the distal end of the forceps channel. Furthermore, since the outer diameter of the joint portion of the loop wire and the operation wire does not increase, the clearance with the inner surface of the introduction pipe can be maintained, and the contact resistance does not increase, so that the insertion property of the operation wire is deteriorated. There is no. According to this invention, since the engagement structure between the clip and the operation wire is simplified and the number of parts can be reduced, the manufacturing cost can be reduced.

  Embodiments of the present invention will be described below with reference to the drawings.

  1 to 6 show a first embodiment, and FIGS. 1 to 3 are longitudinal side views of a distal end portion of a clip device for living tissue. The introduction tube 1 has flexibility that can be inserted into the channel of the endoscope, and a distal end tip 2 is provided at the distal end portion of the introduction tube 1. The tip 2 is fixed to the tip of the introduction tube 1 by welding, bonding or press fitting. An operation wire 4 is inserted into the introduction tube 1 so as to be able to advance and retreat, and a clip 3 which can project and retract from the distal end portion of the introduction tube 1 is detachably connected to the distal end portion of the operation wire 4.

  The introduction tube 1 is, for example, a coil sheath having irregularities on the inner and outer surfaces in which a metal wire (such as stainless steel) having a round cross section is tightly wound, and a force for compressing the sheath is applied to the sheath distal end and the sheath proximal end. Even if this is done, the sheath will not buckle.

  The introduction tube 1 may be, for example, a coil sheath having a flat inner and outer surfaces that are tightly wound after crushing a metal wire (such as stainless steel) having a round cross section and making the wire cross section rectangular. In this case, since the inner surface is flat, it is easy to project the clip 3 and insert the operation wire 4. Further, a coil sheath having a large inner diameter can be realized even when the same wire diameter is used as compared with a round coil sheath. Thus, the protrusion of the clip 3 and the insertion of the operation wire 4 are further facilitated.

  Furthermore, the introduction tube 1 is made of, for example, a polymer resin (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylvinyl ether copolymer, tetrafluoroethylene- A tube sheath of hexafluoropropylene copolymer or the like may be used. In this case, since the inner and outer surfaces of the sheath are slidable, insertion into and removal from the endoscope channel, protrusion of the clip 3, and insertion of the operation wire 4 are facilitated.

  In addition, the introduction tube 1 may be, for example, a tube sheath in which a wall portion is a double tube having an inner layer and an outer layer, and a reinforcing member is interposed between the double tubes. In this case, the inner layer and the outer layer are formed of the above polymer resin. The reinforcing member is formed of, for example, a cylindrical blade knitted in a lattice shape with thin metal wires. As a result, even when a force for compressing the sheath is applied to the distal end portion and the proximal end portion of the sheath, the sheath is superior in compression resistance and does not buckle as compared with the tube sheath in which the reinforcing member is not embedded. .

  The dimension of the introduction tube 1 is an outer diameter that can be inserted into the endoscope channel, and the thickness of the sheath is determined by the rigidity of the material, but a metal sheath has a high thickness of about 0.2 to 0.7 mm. In the case of a molecular resin tube, the thickness is about 0.3 to 0.8 mm. However, by embedding a reinforcing member, there is an advantage that the thickness can be reduced and the sheath inner diameter can be increased.

  The tip 2 is a short tube made of metal (such as stainless steel), has an outer peripheral surface that is tapered, and a tip that is tapered. This facilitates the insertion of the introduction tube 1 into the endoscope channel. Further, the inner peripheral surface is also tapered, so that the clip 3 is easier to protrude than the tip 2. Further, the inner diameter of the distal end portion of the distal end tip 2 is dimensioned so that a protrusion provided on an arm portion of the clip 3 described later can be engaged and the arm portion of the clip 3 can be opened. The tip outer diameter of the tip 3 is φ1.5 to 3.3 mm, and the tip inner diameter of the tip 3 is about φ1.0 to 2.2 mm.

  As shown in FIG. 5, the clip 3 is formed by bending a thin metal strip at a central portion and forming the bent portion as a base end portion 3a, and both arm portions 3b and 3b extending from the base end portion 3a. Bend 'in the spreading direction. Further, the front edge portions of the respective arm portions 3b and 3b 'are bent so as to face each other, and these are defined as sandwiching portions 3c and 3c'. One end of the sandwiching portions 3c and 3c ′ is formed in a convex shape 3d and the other in a concave shape 3e so that the living tissue 5 (see FIG. 3) can be easily grasped. The arm portions 3b and 3b 'are provided with an open extension so as to open the sandwiching portion 3c. A flange 3f protruding rearward is attached to the base end portion 3a. The flange 3f is formed by bending a stainless steel thin plate extending from the base end 3a into a substantially J shape.

  Each of the arms 3b and 3b ′ is provided with protrusions 3g and 3g ′ that can be engaged with the tip 2 when the clip 3 is ligated (when the clip base end is pulled into the tip). .

  The material of the thin strip of the clip 3 is made of, for example, stainless steel having a spring property, so that it has rigidity and can securely grasp the living tissue.

  For example, if the arms 3b and 3b 'are imparted with a spreading ability as a superelastic alloy such as a nickel titanium alloy, the arms 3b and 3b' are more reliably opened when protruding from the sheath.

  When a tensile force of about 1 to 5 kg is applied to the flange 3f provided at the base end portion of the clip 3, the flange 3f cannot maintain the J-shape, deforms, and extends into a substantially I-shape.

  Further, the thickness of the strip plate of the clip 3 is 0.15 to 0.3 mm, and the plate widths of the clamping portions 3c and 3c 'are 0.5 to 1.2 mm. The plate widths of the arm portions 3b and 3b 'are 0.5 to 1.5 mm. The size of the protrusions 3g and 3g 'is 0.2 to 0.5 mm. The plate width of the base end 3a is 0.3 to 0.5 mm. The flange 3f is projected from the proximal end portion 3a of the clip 3 with a length of about 1 to 3 mm.

  As shown in FIG. 6, the operation wire 4 includes a loop wire 4a and a proximal wire 4b. A loop wire 4a closed at the tip of a proximal end wire 4b made of a metal strand is formed. The loop wire 4a is formed by one strand of the proximal end wire 4b. When a twisted core wire is used for the loop wire 4a, the assemblability is good. The core wire may be a stranded wire or a single wire. Joining of the loop wire 4a and the proximal end wire 4b is welded or bonded via a metal connection pipe 4c. The loop wire 4 a is hooked on a flange 3 f provided at the proximal end portion 3 a of the clip 3 and is loaded into the introduction tube 1.

  The operation wire 4 is a stranded wire made of stainless steel, for example. Since it is more flexible than a single wire by using a stranded wire, the flexibility of the introduction tube 1 itself is not impaired.

  A force of 1 to 5 kg is applied to the loop wire 4a when the clip 3 is ligated. At this time, it is necessary to set dimensions so that the loop wire 4a is not broken. The proximal end wire 4b has an outer diameter of φ0.3 to φ0.6 mm, and the loop wire 4a has a diameter of 0.2 mm or more.

  Next, the operation of the first embodiment will be described. The introduction tube 1 of the clip device is introduced into the body cavity through the endoscope channel inserted into the body cavity, and as shown in FIG. 1, the distal end portion of the introduction tube 1 is clipped tissue 5, for example, gastric mucosa tissue. Located in the vicinity of The clip 3 is protruded from the distal end portion of the distal end tip 2 by extruding the operation wire 4 toward the distal end of the introduction tube 1. Since the clip 3 is imparted with an openability to the arm portions 3b and 3b ′ so as to open the sandwiching portions 3c and 3c ′, as shown in FIG. 3c 'is opened. When the operation wire 4 is pulled in a state where the clamping portions 3c and 3c ′ are pressed against the target tissue 5, the proximal end portion 3a of the clip 3 is drawn into the distal tip 2 and the arm portions 3b and 3b ′ of the clip 2 are pulled. The projections 3g and 3g ′ provided on the front end engage with the front end portion of the front end tip 2. When the operation wire 4 is further pulled, the proximal end portion 3a of the clip 3 is plastically deformed and the sandwiching portions 3c and 3c 'are closed, so that the target tissue 5 can be sandwiched as shown in FIG.

  Here, the operation wire 4 is further pulled, and a traction force is applied to the flange 3f attached to the proximal end portion 3a of the clip 3. As a result, the flange 3f bent in a J-shape is extended, the loop wire 4a is separated from the flange 3f, and the operation wire 4 and the clip 3 are completely separated. Thereby, as shown in FIG. 4, placement of the clip 3 on the target tissue 5 is completed.

  According to the first embodiment, by directly engaging the clip and the operation wire, the number of parts of the engagement portion between the clip and the operation wire is reduced. Thereby, the manufacturing cost can be reduced. In addition, it is easy to attach the clip during manufacture. In addition, after the first clip is placed in the living tissue, the clip device is removed from the endoscope channel, and when the second clip is reloaded, the clip wire is simply hooked on the loop of the clip. Will also be easier.

  7 and 8 show a second embodiment, FIG. 7 is a side view of the distal end portion of the operation wire, and FIG. 8 shows a method for manufacturing the operation wire.

  JP, 2000-271146, A, etc. are known for a wire which has a closed loop part in a tip part shown in a 1st embodiment mentioned above.

  A loop wire forming a closed loop is joined to the tip of the operation wire via a joining pipe. However, in such a structure, a joining pipe for joining the operation wire and the loop wire is necessary.

  On the other hand, it has already been made to form a closed loop by using the core wire of the stranded wire as the loop wire. However, a joining pipe is required to join the loop wire and the operation wire.

  As a result, the number of parts increases, and the number of assembly man-hours due to joining operations such as welding, adhesion, caulking and the like increases accordingly. And there existed a problem that manufacturing cost will increase.

  On the other hand, the provision of the joining pipe also has a problem that a hard part is formed at the joining part of the loop wire and the operation wire. By forming a hard part, flexibility is lost, and the insertion property to the forceps channel of the endoscope is deteriorated. Further, when the angle of the endoscope is applied, there is a problem that the hard portion cannot be inserted through the angle of the endoscope and cannot protrude from the tip of the forceps channel.

  Furthermore, by providing the joining pipe, the outer diameter of the joint portion between the loop wire and the operation wire is increased. As the outer diameter increases, the clearance with the inner surface of the introduction tube (insertion portion) constituting the endoscope treatment tool decreases, and the contact resistance also increases. Originally, the inner diameter of the introduction tube of the endoscope treatment instrument is very small, about φ1 to 2.5 mm, and even a slight increase in the outer diameter has a problem that its insertion property is greatly deteriorated. It was.

  In order to solve the above problem, as shown in FIG. 7, the operation wire 5 includes a loop wire 5a and a proximal end wire 5b. The proximal end wire 5b is composed of a metal stranded wire, and is stranded with, for example, three strands.

  Next, a method of manufacturing the operation wire 5 (for example, a method of manufacturing with a 1 × 3 twisted wire) will be shown based on FIG. The outer diameter of the wire is about φ0.3 to 0.6 mm.

  1. As shown in FIG. 8A, the wire end portion 5c is loosened.

  2. As shown in FIG. 8 (b), one of the three wires A is loosened while turning. At this time, the length of about 60 mm is loosened from the wire end 5c.

  3. As shown in FIG. 8C, the second wire B or C is similarly loosened. At this time, the length of about 60 mm is similarly loosened from the wire end 5c.

  4). As shown in FIG. 8D, the second wire B or C is folded back. At this time, the folding end X and the unwinding end Y should be sufficiently separated. Further, as shown in the enlarged view, the folding is easier to bend when it is bent at a place where it becomes a mountain.

  5. As shown in FIG. 8E, the bent wire B is twisted by turning in the unwinding direction (in the case of Z twisting). At this time, the deformed portion at the end is cut before twisting. As shown in FIG. 8F, the untwisting length is about 30 mm.

6). As shown in FIG. 8 (f), the wire C is returned to the wire B, twisted to the wire B, and cut at the position where the wire B is turned back. At this time, the wires C and B are not spaced from each other and do not overlap. (It becomes easy to come off later when wire A is returned)
7). As shown in FIG. 8G, the wire A is returned to the wires B and C and twisted. At this time, the contact portion between the wire C and the wire B is preferably performed under a stereoscopic microscope. Also, when twisting the front and rear of the contact portion, take care not to move the wires C and B.

  Furthermore, as shown in FIG. 8 (h), when placing the wire A, care should be taken not to flip the wires B and C in the direction of the black arrow. Further, when placing the wire A, placing the wire A on the tip side (loop side) with respect to the contact portion between the wires B and C facilitates placing the wire A.

  8). As shown in FIG. 8 (i), the wire A is cut at the edge of the loop (a portion).

  9. As shown in FIG. The loop has a length of about 5 mm. Further, the wire B and C contact portions and the end portion of the wire A may be prevented from loosening by twisting or bonding.

  The effect | action of 2nd Embodiment is the same as 1st Embodiment, and abbreviate | omits description. According to the second embodiment, since there is no connection pipe 4c as compared with the operation wire 4 of the first embodiment, the number of parts is reduced, and this is caused by joining work such as welding, adhesion, caulking, and the like. Since the number of assembling steps can be reduced, the manufacturing cost can be reduced. Further, since the outer diameter does not increase at the joint portion between the proximal end wire 5 and the loop wire 5a, the insertion resistance of the operation wire 5 is maintained without increasing the frictional resistance with the inner surface of the introduction tube 1. Thus, the clip 3 can be easily protruded from the introduction tube 1. Further, since there is no hard portion at the joint portion between the loop wire and the operation wire, flexibility can be maintained, and insertion of the endoscope into the forceps channel can be maintained.

  FIG. 9 shows a third embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted. FIG. 9 is a plan view and a side view of the clip and the operation wire. The operation wire 6 has a distal end portion bent in a flat loop shape and engaged with the flange 3 f of the clip 3, and the two operation wires 6 are inserted to the proximal end portion of the introduction tube 1.

  The operation wire 6 may be coated with a polymer resin 6a having good slipperiness such as high density / low density polyethylene or polytetrafluoroethylene. The optimum thickness of the coating is about 0.05 mm to 0.1 mm. Furthermore, in order to improve the slipperiness of the operation wire 6, it is also effective to apply an embossing of 0.01 mm to 0.45 mm to the surface of the wire or apply silicone oil. The operation wire 6 is a metal wire such as a stranded wire or a single wire stainless steel and has an outer diameter of about 0.2 to 0.5 mm.

  The action of the third embodiment pulls the two operation wires 6 together. Other operations are the same as those in the first embodiment, and a description thereof will be omitted. According to the third embodiment, the clip and the operation wire can be engaged with each other with a simpler configuration as compared with the first and second embodiments. By providing the coating of the polymer resin 6a, the slidability of the operation wire is increased, the frictional resistance with the inner surface of the introduction pipe is reduced, and the amount of traction force can be transmitted to the tip of the introduction pipe without loss, thereby reducing the force. A ligation operation can be performed.

  FIG. 10 shows a fourth embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  The clip 8 of the present embodiment is obtained by eliminating the flange 3f of the clip 3 in the first embodiment, bending it in a substantially U shape, and directly engaging the loop wire 4a with the base end portion 8a of the clip 8. The wire diameter of the loop wire 4a is set to about φ0.1 to φ0.2 mm.

  Next, the operation of the fourth embodiment will be described. The operation wire 4 is pulled in a state where the sandwiching portions 3 c and 3 c ′ are close to the target tissue 5. The arm portions 3 b and 3 b ′ of the clip 8 bent in the expanding direction engage with the distal end portion of the distal end tip 2. Here, when the operation wire 4 is further pulled while the clamping portions 3c and 3c ′ are pressed against the target tissue 5, the arm portions 3b and 3b ′ of the clip 8 are drawn into the distal tip 2 and the clamping portions 3c and 3c ′. When the is closed, the target tissue 5 can be sandwiched. Further, by pulling the operation wire 4, the loop wire 4a is broken. A force of 1 to 5 kg is applied to the loop wire 4a when the clip 8 is ligated, and the dimensions are set so that the loop wire 4a is broken when these forces are applied.

  When the loop wire 4a is broken, the clip 8 and the operation wire 4 are separated, and the clip 8 can be placed in the living tissue.

  In this embodiment, the engagement of the clip 8 and the operation wire 4 is separated by the breakage of the loop wire 4a. As a modification thereof, in the loop wire shown in FIG. 8 (f), the untwisted length of the wire B is set short, and the loop 8 is untwisted at the time of ligation so that the clip 8 and the operation wire 4 are engaged. You may make it isolate | separate. As the untwisted length, about 5 to 10 mm is appropriate.

  According to the fourth embodiment, compared to the first embodiment, the clip can be formed at a lower cost because there is no flange 3f of the base end portion 8a of the clip 8.

  11 (a) and 11 (b) show a fifth embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  The clip 9 eliminates the flange 3f of the clip 3 in the first embodiment, is bent in a substantially U shape, and a hole 21 into which the operation wire 10 can be inserted is provided in the base end portion 9a of the clip 9.

  The operation wire 10 is a single wire made of metal and has a diameter of about 0.2 to 0.7 mm. The operation wire 10 is inserted into the hole 21, and a flat bulging portion 10 a that prevents the operation wire 10 from being detached is provided at the tip of the operation wire 10. Examples of the method for forming the flat bulging portion 10a include caulking, laser, and plasma welding. The diameter of the hole 21 is suitably about 0.2 to 0.7 mm, and the operation wire 10 that can be inserted into the hole 21 is used. The maximum diameter of the flat bulging portion 10a is necessarily larger than the diameter of the hole 21 and is about 0.25 to 1 mm.

  Next, the operation of the fifth embodiment will be described.

  The operation wire 10 is pulled with the holding portions 3c and 3c 'of the clip 9 brought close to the target tissue. The arm portions 3 b and 3 b ′ of the clip 9 bent in the expanding direction are engaged with the distal end portion of the distal end tip 2. Here, when the operation wire 10 is further pulled while the sandwiching portions 3c and 3c ′ are pressed against the target tissue 5, the arm portions 3b and 3b ′ of the clip 9 are drawn into the distal tip 2 and the sandwiching portions 3c and 3c ′. By closing, the target tissue can be sandwiched. Further, by pulling the operation wire 10, the flat bulging portion 10a at the distal end of the operation wire 10 is pulled out from the hole 21 of the clip base end portion 3a. As a result, the diameter of the flat bulging portion 10 a is deformed and reduced, or the hole 21 of the base end portion 3 a of the clip 9 is deformed and enlarged, whereby the operation wire 10 is separated from the clip 3. Thereby, the clip 3 can be placed in the living tissue.

  According to the fifth embodiment, by directly engaging the clip and the operation wire, the number of parts of the engagement portion between the clip and the operation wire is reduced. Thereby, the manufacturing cost can be reduced. In addition, it is easy to attach the clip during manufacture.

  12 to 14 show a sixth embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  The tip 2 is welded, bonded or press-fitted to the tip of the insertion tube 1. The tip 2 is a short tube made of metal (stainless steel, etc.), the outer peripheral surface is tapered, and the tip is tapered. For this reason, the insertion property of the introduction tube 1 into the endoscope channel can be facilitated.

  The inner peripheral surface of the tip 2 is also tapered, and the inner diameter of the tip is approximately the same as the outer diameter of a clip tightening ring described later. As a result, rattling of the clip tightening ring is suppressed. The tip end outer diameter of the tip 2 is φ1.5 to 3.3 mm, and the tip inner diameter of the tip 2 is about φ1.0 to 2.2 mm.

  Further, the clip 11 is formed by bending a metal thin strip at the center portion, and the bent portion serves as a base end portion 11a, and both the arm portions 11b and 11b ′ extending from the base end portion 11a intersect each other. . Therefore, the base end part 11a side of the clip 11 is substantially elliptical. Further, the front edge portions of the respective arm portions 11b and 11b 'are bent so as to face each other, and these are defined as sandwiching portions 11c and 11c'. As for the front-end | tip of clamping part 11c, 11c ', one side is formed in the convex shape 11d and the other is formed in the concave shape 11e so that a biological tissue may be grasped easily. Then, the arms 11b and 11b 'were given an open / expanding ability so as to open the sandwiching portions 11c and 11c'. A flange 11f protruding rearward is attached to the base end portion 11a. The flange 11f is formed by previously forming a band plate into a J shape and bending it at the base end portion 11a.

  The material of the thin strip plate that constitutes the clip 11 is, for example, stainless steel having a spring property, is rigid, and can securely grasp the living tissue. Alternatively, for example, if a super elastic alloy such as a nickel titanium alloy is used and the arm portion is provided with a spread habit, the arm portion is more surely opened when it protrudes from the sheath.

  When a tensile force of about 1 to 5 kg is applied to the flange 11f provided at the base end portion of the clip 11, the flange 11f cannot maintain the J-shape, deforms, and extends into a roughly I-shape.

  Moreover, the thickness of the strip of the clip 11 is 0.15 to 0.3 mm. The plate width of the clamping part is 0.5 to 1.2 mm. The plate width of the arm is 0.5 to 1.5 mm. The plate width on the base end side is 0.3 to 0.5 mm. The ridge is protruded with a length of about 1 to 3 mm from the base end of the clip.

  The clip fastening ring 12 provided at the base end portion of the clip 11 is formed of a strong and elastic resin, metal or the like. A pair of two blades 12a and 12a 'which are elastically deformed and can be protruded and retracted in the circumferential direction are provided on the outer periphery of the ring. The number of blades 12a and 12a 'is not limited to one pair and two, but may be three or four.

  When an external force is applied in a vertical direction to the circumferential surface of the clip tightening ring 12, the blades 12a and 12a 'are folded onto the inner surface of the tightening ring. Since the blades 12a and 12a ′ are in contact with the inner surface of the introduction tube and the inner surface of the tip 2, the tip side is inclined surfaces 12b and 12b ′ and can be pushed out from the introduction tube 1 and the tip 2 smoothly and without resistance. it can.

  The clip tightening ring 12 closes the clip arm portions 11b and 11b 'by being fitted to the arm portions 11b and 11b' of the clip 11, and has a substantially tubular shape. The clip 11 and the operation wire 4 are engaged by hooking the loop wire 4a to the flange 11f. In addition, even if the clip 11 is pushed out by the operation wire 4, a polymer material such as silicone 13 is provided so that the engagement between the clip 11 and the operation wire 4 can be maintained and the clip 11 and the clip fastening ring 12 can be temporarily fixed Is inserted into the clip tightening ring 12.

  Although the blades 12a and 12a ′ of the clip tightening ring 12 may be loaded in the introduction tube 1 in a folded state, the blades 12a and 12a ′ may be loaded into the introduction tube 1 with the blades 12a and 12a ′ protruding. The elasticity of 12a 'can be maintained over a long period. In addition, since the contact resistance between the inner surface of the introduction pipe 1 and the blades is reduced, the force when the clip 11 is moved in the introduction pipe 1 can also be reduced.

  The clip fastening ring 12 is formed by injection molding, for example, a strong and elastic resin (polybutyterephthalate, polyamide, polyphenylamide, liquid crystal polymer, polyetherketone, polyphthalamide). Alternatively, for example, an elastic metal (superelastic alloy such as stainless steel or nickel titanium alloy) is formed by injection molding, cutting, plastic processing, or the like.

  The tubular part of the clip tightening ring 12 has an inner diameter of about 0.6 to 1.3 mm and an outer diameter of about 1.0 to 2.1 mm. The outermost diameter portion when the blades 12a and 12a 'protrude is set to 1 mm or more in consideration of the engagement with the tip 2.

  Next, the operation of the sixth embodiment will be described. The tip of the introduction tube 1 is guided to the target site while observing the inside of the body cavity with an endoscope. A clip 11 and a clip fastening ring 12 loaded in the introduction tube 1 are projected from the tip 2. This is realized by pushing the operation wire 4 toward the distal end side of the introduction tube 1. The blades 12 a and 12 a ′ of the clip fastening ring 12 are folded when passing through the tip 2, but when passing through the tip 2, the blades 12 a and 12 a ′ project again. This prevents the clip clamping ring 12 from entering the tip 2 again.

  When the operation wire 4 is pulled in a state where the clip portions 11 c and 11 c ′ of the clip 11 are close to the target tissue, the blades 12 a and 12 a ′ of the clip tightening ring 12 are engaged with the end face of the tip 2. When the operation wire 4 is further pulled, the elliptical portion of the proximal end portion 11 a of the clip 11 is drawn into the clip tightening ring 12. Here, since the dimension of the elliptical part is larger than the inner diameter of the clip fastening ring 12, the elliptical part is crushed by the clip fastening ring 12. Then, the arm portions 11b and 11b 'are greatly expanded outward.

  In this state, as shown in FIG. 13, the clip 11 is guided so as to sandwich the target biological tissue 14. Further, by pulling the operation wire 4, the arm portions 11 b and 11 b ′ of the clip 11 are drawn into the clip fastening ring 12, and the clamping portions 11 c and 11 c ′ of the clip 11 are closed. The operation wire 4 is further pulled in a state where the living tissue 14 is securely sandwiched between the arm portions 11b and 11b 'of the clip, and the hook 11f is stretched to release the engagement between the clip 11 and the operation wire 4. Thereby, the clip 11 can be placed in the body cavity while holding the living tissue 14.

  According to the sixth embodiment, in addition to the effects of the first embodiment, there are the following effects. Since the clip arm is closed by the clip tightening ring, the living tissue can be ligated with a stronger force.

  FIG. 15 shows a seventh embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  A flexible operation member 15 is provided in the introduction tube 1 so as to be freely advanced and retracted. The operation member 15 is disposed behind a clip tightening ring 16 (described later) loaded in the introduction tube 1 and directly receives the force applied by the operation wire 4 when the clip 11 is ligated.

  The operation member 15 is, for example, a coil sheath having irregularities on the inner and outer surfaces of a metal wire (stainless steel or the like) having a round cross section, and by moving the operation member 15 toward the distal end side with respect to the introduction tube 1, The clip 11 and the clip fastening ring 16 can be protruded from the introduction tube 1.

  The operation member 15 may be, for example, a square coil sheath having flat inner and outer surfaces that are crushed by a metal wire (such as stainless steel) having a round cross section, and the wire cross section is made rectangular and then tightly wound. Further, a coil sheath having a large inner diameter can be realized even when the same wire diameter is used as compared with a round coil sheath. Thereby, the protrusion of the clip and the insertion of the operation wire become easier.

  Further, the operation member 15 is made of, for example, a polymer resin (synthetic polymer polyamide, high density / low density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkylene vinyl ether copolymer, tetrafluoroethylene- A tube sheath of hexafluoropropylene copolymer or the like may be used. Since the inner and outer surfaces of the sheath are slippery, insertion through the introduction tube 1 and insertion of the operation wire 4 are facilitated.

  Further, the operation member 15 may be, for example, a tube sheath having a wall portion having an inner layer and an outer layer and embedded with a reinforcing member interposed between the double tubes. The inner layer and the outer layer are formed of the polymer resin as described above. The reinforcing member is formed of, for example, a cylindrical blade knitted in a lattice shape with thin metal wires. As a result, even when a force for compressing the sheath is applied to the distal end portion and the proximal end portion of the sheath, the sheath is superior in compression resistance and does not buckle as compared with the tube sheath in which the reinforcing member is not embedded. .

  The operation member 15 has an outer diameter that can be inserted into the introduction tube 1 and an inner diameter that allows the operation wire 4 to be inserted, and has an outer diameter of 3 mm or less. The inner diameter should be as large as possible. However, the thickness of the protrusion 11 is required to be able to reliably transmit the protrusion force and not to buckle even if a force is applied when the clip 11 is ligated.

  The clip tightening ring 16 closes the arm portions 11b and 11b 'of the clip 11 by being fitted to and mounted on the arm portions 11b and 11b' of the clip 11, and has a substantially tubular shape. The clip 11 and the operation wire 4 are engaged by hooking the loop wire 4a to the flange 11a.

  For example, the clip fastening ring 16 is formed by injection molding of a strong resin (polybutyterephthalate, polyamide, polyphenylamide, liquid crystal polymer, polyetherketone, polyphthalamide) or the like. Alternatively, for example, a metal (such as stainless steel) may be formed by injection molding, cutting, plastic processing, or the like.

  Further, the clip tightening ring 16 has an inner diameter of 0.6 to 1.3 mm and an outer diameter of about 1.0 to 2.1 mm.

  Next, the operation of the seventh embodiment will be described. The tip of the introduction tube 1 is guided to the living tissue 14 while observing the inside of the body cavity with an endoscope. The clip 11 and the clip clamping ring 16 loaded in the introduction tube 1 are protruded from the introduction tube 1. This is realized by pushing the operating member 15 toward the distal end side of the introduction tube 1. Alternatively, it can be realized by pulling the introduction pipe 1 to the proximal end side.

  When the operation wire 4 is pulled in a state where the clip portions 11c and 11c 'of the clip 11 are close to the living tissue 14, the base end surface 16a of the clip tightening ring 16 is engaged with the operation member front end surface 15a. When the operation wire 4 is further pulled, the elliptical portion of the proximal end portion 11 a of the clip 11 is drawn into the clip fastening ring 16. Here, since the dimension of the ellipse is larger than the inner diameter of the clip tightening ring 16, the ellipse is crushed by the clip tightening ring 16. Then, the arm portions 11b and 11b 'are greatly expanded outward.

  In this state, the clip 11 is guided so as to sandwich the target biological tissue 14. Further, by pulling the operation wire 4, the arm portions 11 b and 11 b ′ of the clip 11 are drawn into the clip fastening ring 16, and the clamping portions 11 c and 11 c ′ of the clip 11 are closed. The operation wire 4 is further pulled while the living tissue 14 is securely held between the clip holding portions 11c and 11c ', and the hook 11f is stretched to release the engagement between the clip 11 and the operation wire 4. Thereby, the clip 11 can be placed in the body cavity while holding the living tissue 14.

  According to the seventh embodiment, in addition to the effects of the sixth embodiment, there are the following effects. The operation of protruding the clip from the introduction tube can be performed more easily and reliably.

  16 and 17 show an eighth embodiment, and a clip 17 and an operation wire 18 are different from the seventh embodiment. The clip 17 does not have the flange 11f of the clip 11 shown in the seventh embodiment. Other configurations are the same as those of the clip 11.

  The operation wire 18 is made of a single wire or a stranded wire metal wire, and a tip portion is bent to form a loop portion 18a. The outer diameter is about φ0.3 to φ0.6 mm. As shown in FIG. 16, the loop portion 18 a of the operation wire 18 is directly engaged with the proximal end portion 17 a of the clip 17.

  When the clip is ligated, if a force of 1 to 5 kg is applied to the loop portion 18a, the loop portion 18a is stretched substantially linearly as shown in FIG. Thereby, the engagement between the clip 17 and the operation wire 18 is released.

  Next, the operation of the eighth embodiment will be described. When the operation wire 18 is pulled in a state where the holding portion of the clip 17 is close to the living tissue 14, the proximal end surface 16a of the clip fastening ring 16 is engaged with the operation member distal end surface 15a. When the operation wire 18 is further pulled, the elliptical portion of the base end portion of the clip 17 is larger than the inner diameter of the clip fastening ring 16, so that the elliptical portion is crushed by the clip fastening ring 16. Then, the arm portions 17b and 17b 'are greatly expanded outward.

  In this state, the clip 11 is guided so as to sandwich the target biological tissue 14. Further, by pulling the operation wire 18, the arm portions 17 b and 17 b ′ of the clip 17 are drawn into the clip tightening ring 16 and the clamping portion of the clip 17 is closed. The operation wire 18 is further pulled in a state where the living tissue 14 is securely sandwiched between the clip 17 and the loop portion 18a is stretched substantially linearly. Thereby, the engagement between the clip 17 and the operation wire 18 is released, and the clip 17 can be placed in the body cavity while holding the living tissue 14.

  According to the eighth embodiment, in addition to the effects of the seventh embodiment, there are the following effects. Since it is not necessary to mold the flange 11f at the base end portion of the clip 17, the clip 17 can be manufactured at a lower cost. In addition, since the loop portion 18a at the distal end of the operation wire 18 also only bends the wire, the operation wire 18 can be formed at a lower cost and can be easily engaged with the proximal end portion of the clip 17.

  FIG. 18 shows a ninth embodiment, and (a) to (d) are longitudinal side views showing the operation of the biological tissue clip device. The same components as those in the seventh embodiment are denoted by the same reference numerals and description thereof is omitted. An operation wire 10 is inserted through the operation member 15 so as to be able to advance and retract.

  The clip 9 has the same structure as that of the fifth embodiment shown in FIGS. 11A and 11B, and a hole 21 into which the operation wire 10 can be inserted is provided in the base end portion 9 a of the clip 9. A bulging portion 10 a that is larger than the hole 21 is provided at the distal end portion of the operation wire 10. Further, a clip fastening ring 16 made of a cylindrical pipe is interposed between the distal end surface of the operation member 15 and the proximal end portion of the clip 9 in a state of being inserted into the operation wire 10.

  Next, the operation of the ninth embodiment will be described. As shown in FIG. 18 (a), before the ligation, the clip 9 is loaded at the distal end portion of the introduction tube 1, and the operation member 15 is connected to the proximal end portion 9 a of the clip 9 via the clip fastening ring 16. Abut.

  As shown in FIG. 4B, when the operating member 15 is advanced or the introduction tube 1 is retracted, the clip 9 and the clip fastening ring 16 protrude from the distal end portion of the introduction tube 1. In this state, when the operation wire 10 is pulled, the base end portion 9a of the clip 9 is drawn into the clip tightening ring 16, and as shown in FIG. It expands greatly. At this time, the force applied by the operation wire 10 can be reliably received by the operation member 15 via the clip tightening ring 16.

  In this state, when the operation wire 10 is further pulled while the holding portions 9c and 9c ′ of the clip 9 are pressed against the target tissue 14, the arm portions 9b and 9b ′ of the clip 9 are drawn into the clip fastening ring 16. By closing the clamping portions 9c and 9c ′, the target tissue 14 can be sandwiched as shown in FIG. Further, by pulling the operation wire 10, the hole 21 of the base end portion 9a of the clip 9 is deformed and enlarged by the bulging portion 10a at the distal end of the operation wire 10, or the diameter of the bulging portion 10a is deformed and reduced. The operation wire 10 is separated from the clip 9. Thereby, the clip 9 can be placed in the living tissue.

  According to the ninth embodiment, by directly engaging the clip and the operation wire, the number of parts of the engagement portion between the clip and the operation wire is reduced. Thereby, the manufacturing cost can be reduced. In addition, it is easy to attach the clip during manufacture.

  Moreover, since the force applied by the operation wire can be reliably received by the operation member, the living tissue can be ligated with a stronger force. Further, since the clip arm is closed by the clip tightening ring, the living tissue can be ligated with a stronger force.

  FIG. 19 shows a tenth embodiment, and (a) to (c) are longitudinal side views showing the operation of the biological tissue clip device. The same components as those in the seventh embodiment are denoted by the same reference numerals and description thereof is omitted. An operation wire 10 is inserted through the operation member 15 so as to be able to advance and retract.

  The clip 9 has the same structure as the fifth embodiment and the ninth embodiment shown in FIGS. 11A and 11B, and the base end portion 9a of the clip 9 has a hole 21 through which the operation wire 10 can be inserted. Is provided. A bulging portion 10 a that is larger than the hole 21 is provided at the distal end portion of the operation wire 10. Further, a clip fastening ring 12 as an engaging means having the same structure as that of the sixth embodiment shown in FIG. 14 is inserted between the distal end surface of the operation member 15 and the base end portion of the clip 9 through the operation wire 10. Intervened in a state.

  Next, the operation of the tenth embodiment will be described. As shown in FIG. 19 (a), before the ligation, the clip 9 is loaded at the distal end portion of the introduction tube 1, and the operation member 15 is connected to the proximal end portion 9 a of the clip 9 via the clip fastening ring 12. Abut.

  As shown in FIG. 4B, when the operation member 15 is advanced or the introduction tube 1 is retracted, the clip 9 and the clip fastening ring 12 protrude from the distal end portion of the introduction tube 1. In this state, when the operation wire 10 is pulled, the base end portion 9a of the clip 9 is drawn into the clip tightening ring 12, and the arm portions 9b and 9b ′ of the clip 9 are moved as shown in FIG. It expands greatly. At this time, the blades 12 a and 12 a ′ of the clip fastening ring 12 are folded when passing the tip 2, but when passing the tip 2, the blades 12 a and 12 a ′ project again and engage with the tip 2. . Therefore, the clip clamping ring 12 can be prevented from entering the tip 2 again, and the force applied by the operation wire 10 can be reliably received by the tip 2 via the clip clamping ring 16.

  In this state, similarly to the ninth embodiment, when the operation wire 10 is further pulled in a state where the clamping portions 9c and 9c ′ of the clip 9 are pressed against the target tissue 14, the arms 9b and 9b ′ of the clip 9 are clipped. The target tissue 14 can be sandwiched by being drawn into the tightening ring 16 and closing the sandwiching portions 9c and 9c ′. Further, by pulling the operation wire 10, the hole 21 of the base end portion 9a of the clip 9 is deformed and enlarged by the bulging portion 10a at the distal end of the operation wire 10, or the diameter of the bulging portion 10a is deformed and reduced. The operation wire 10 is separated from the clip 9. Thereby, the clip 9 can be placed in the living tissue.

  According to the tenth embodiment, in addition to the ninth embodiment, the force applied by the operation wire can be reliably received by the engaging means, so that the living tissue can be ligated with a stronger force. Further, since the clip arm is closed by the clip tightening ring, the living tissue can be ligated with a stronger force.

  FIG. 20 shows an eleventh embodiment, and (a) to (c) are longitudinal side views showing the operation of the clip device for living tissue. The same components as those in the fifth embodiment are denoted by the same reference numerals and description thereof is omitted.

  As shown in FIG. 20, the operation wire includes a bulging portion 10a and a proximal end wire 10 '. The proximal wire 10 'and the operation wire 10 are welded or bonded. Alternatively, when the core wire of the proximal end wire 10 ′ composed of a stranded metal wire is used for the operation wire 10, only one wire is required and the number of parts is reduced, so that the manufacturing cost can be reduced. The diameter of the proximal end wire 10 'is about 0.3 to 1.5 mm.

  The clip 3 has basically the same structure as that of the first embodiment shown in FIGS. 1 to 5, and a hole 21 is provided in the base end portion 3a as in the ninth embodiment. A plurality of clips 3 are loaded in series in the introduction tube 1, the operation wire 10 is inserted through the hole 21 of each clip 3, and the bulging portion 10 a is locked in the hole 21 of the clip 3 at the foremost end. The wire 10 is prevented from coming off.

  Next, the operation of the eleventh embodiment will be described. As shown in FIG. 21A, before the ligation, a plurality of clips 3 are loaded in series at the distal end portion of the introduction tube 1, and the bulging portion 10a is engaged with the hole 21 of the clip 3 at the foremost end. It has been stopped.

  As shown in FIG. 6B, when the proximal wire 10 ′ is advanced or the introduction tube 1 is retracted, the foremost clip 3 protrudes from the distal end portion of the introduction tube 1 and the arms 3b and 3b ′ are greatly expanded. Open. In this state, when the proximal end wire 10 'is pulled, the proximal end portion 3a of the clip 3 is drawn into the distal tip 2 and is moved to the arm portions 3b and 3b' of the clip 3 as shown in FIG. The provided projections 3g and 3g ′ engage with the tip of the tip 2. Further, when the proximal end wire 10 ′ is pulled, the proximal end portion 3 a of the clip 3 is plastically deformed, and the sandwiching portions 3 c and 3 c ′ are closed to sandwich the target tissue 14.

  When the proximal end wire 10 ′ is further pulled, the hole 21 in the proximal end portion 3 a of the clip 3 is deformed and enlarged by the bulging portion 10 a at the distal end of the operation wire 10, so that the operation wire 10 is separated from the clip 3 and the clip 3. Can be placed in the living tissue.

  Next, when the proximal wire 10 ′ is advanced or the introduction tube 1 is retracted, the bulging portion 10 a of the operation wire 10 is engaged with the hole 21 of the second clip 3, and the second clip 3 is attached to the introduction tube 1. The clip 3 can be protruded from the distal tip 2 and the clip 3 can be continuously ligated by repeating the same operation.

  According to the eleventh embodiment, since the engagement structure between the clip and the operation wire is simplified and the number of parts can be reduced, the manufacturing cost can be reduced. Further, the clip mounting operation can be facilitated at the time of manufacture, and assembling variation can be prevented. Furthermore, since the clip in the introduction tube is positioned near the center by the operation wire, the clip can be pushed out with a low amount of force. In addition, since the clip can be ligated continuously only by pulling one base end wire, the operability can be improved.

  FIG. 21 shows a twelfth embodiment, and (a) to (d) are longitudinal side views showing the operation of the clip device for living tissue. The same components as those of the ninth embodiment are denoted by the same reference numerals and description thereof is omitted.

  A plurality of clips 9 and a plurality of clip fastening rings 16 are alternately loaded in series inside the introduction pipe 1. The clip 9 and the clip fastening ring 16 have the same structure as that of the ninth embodiment shown in FIG. 18, and a hole 21 into which the operation wire 10 can be inserted is provided in the base end portion 9 a of the clip 9. A bulging portion 10 a that is larger than the hole 21 is provided at the distal end portion of the operation wire 10.

  Further, a clip fastening ring 16 formed of a cylindrical pipe is interposed between the distal end surface of the operation member 15 and the base end portion of the clip 9 in a state where the operation wire 10 is inserted. The operation wire 10 is inserted through the hole 21 of each clip 9, the bulging portion 10 a is locked in the hole 21 of the clip 9 at the foremost end, and the operation wire 10 is prevented from coming off.

  Next, the operation of the twelfth embodiment will be described. As shown in FIG. 21 (a), before the ligation, a plurality of clips 9 and a plurality of clip fastening rings 16 are alternately loaded in series inside the introduction tube 1, and the tip of the operation member 15 is The rear end of the clip fastening ring 16 is in contact with the proximal end.

  As shown in FIG. 2B, when the operation member 15 is advanced or the introduction tube 1 is retracted, the foremost clip 9 and the clip fastening ring 16 protrude from the distal end portion of the introduction tube 1. In this state, when the operation wire 10 is pulled, the base end portion 9a of the clip 9 is drawn into the clip tightening ring 16, and as shown in FIG. It expands greatly. At this time, the force applied by the operation wire 10 can be reliably received by the operation member 15 via the clip tightening ring 16.

  In this state, when the operation wire 10 is further pulled in a state where the clamping portions 9c and 9c ′ of the clip 9 are pressed against the target tissue 14, the arm portions 9b and 9b ′ of the clip 9 are drawn into the clip tightening ring 16, By closing the clamping portions 9c and 9c ′, the target tissue 14 can be sandwiched as shown in FIG. Further, by pulling the operation wire 10, the hole 21 in the proximal end portion 9 a of the clip 9 is deformed and enlarged by the bulging portion 10 a at the distal end of the operation wire 10, and the operation wire 10 is separated from the clip 9. Thereby, the clip 9 can be placed in the living tissue.

  Next, when the operation member 15 is advanced or the introduction tube 1 is retracted, the bulging portion 10 a of the operation wire 10 is engaged with the hole 21 of the second clip 9, and the second clip 9 is moved from the distal end of the introduction tube 1. The clip 9 can be ligated continuously by repeating the same operation.

  According to the twelfth embodiment, in addition to the effects of the eleventh embodiment, the force applied by the operation wire can be reliably received by the operation member, so that the living tissue can be ligated with a stronger force. Further, since the clip arm is closed by the clip tightening ring, the living tissue can be ligated with a stronger force.

  FIG. 22 shows a thirteenth embodiment, and (a) to (c) are longitudinal side views showing the operation of the biological tissue clip device. The same components as those of the tenth embodiment are given the same reference numerals and the description thereof is omitted.

  A plurality of clips 9 and a plurality of clip fastening rings 12 are alternately loaded in series inside the introduction pipe 1. The clip 9 and the clip fastening ring 12 have the same structure as that of the tenth embodiment shown in FIG. 19, and a hole 21 into which the operation wire 10 can be inserted is provided in the base end portion 9 a of the clip 9. A bulging portion 10 a that is larger than the hole 21 is provided at the distal end portion of the operation wire 10. Further, a clip fastening ring 12 as an engaging means having the same structure as that of the tenth embodiment is interposed between the distal end surface of the operation member 15 and the base end portion of the clip 9 in a state where the operation wire 10 is inserted. ing.

  Next, the operation of the thirteenth embodiment will be described. As shown in FIG. 23 (a), before the ligation, a plurality of clips 9 and a plurality of clip fastening rings 12 are alternately loaded in series inside the introduction tube 1, and the operation member 15 The distal end is in contact with the proximal end of the rearmost clip fastening ring 12.

  As shown in FIG. 2B, when the operation member 15 is advanced or the introduction tube 1 is retracted, the foremost clip 9 and the clip tightening ring 12 protrude from the distal end portion of the introduction tube 1. In this state, when the operation wire 10 is pulled, the base end portion 9a of the clip 9 is drawn into the clip tightening ring 12, and the arm portions 9b and 9b ′ of the clip 9 are moved as shown in FIG. It expands greatly. At this time, the blades 12 a and 12 a ′ of the clip fastening ring 12 are folded when passing the tip 2, but when passing the tip 2, the blades 12 a and 12 a ′ project again and engage with the tip 2. . Therefore, the clip clamping ring 12 can be prevented from entering the tip 2 again, and the force applied by the operation wire 10 can be reliably received by the tip 2 via the clip clamping ring 16.

  In this state, similarly to the ninth embodiment, when the operation wire 10 is further pulled in a state where the clamping portions 9c and 9c ′ of the clip 9 are pressed against the target tissue 14, the arms 9b and 9b ′ of the clip 9 are clipped. The target tissue 14 can be sandwiched by being drawn into the tightening ring 16 and closing the sandwiching portions 9c and 9c ′. Further, by pulling the operation wire 10, the hole 21 in the proximal end portion 9 a of the clip 9 is deformed and enlarged by the bulging portion 10 a at the distal end of the operation wire 10, and the operation wire 10 is separated from the clip 9. Thereby, the clip 9 can be placed in the living tissue. Next, when the operation member 15 is advanced or the introduction tube 1 is retracted, the bulging portion 10 a of the operation wire 10 is engaged with the hole 21 of the second clip 9, and the second clip 9 is moved from the distal end of the introduction tube 1. The clip 9 can be ligated continuously by repeating the same operation.

  According to the thirteenth embodiment, in addition to the eleventh embodiment, the force applied by the operation wire can be reliably received by the engaging means, so that the living tissue can be ligated with a stronger force. Further, since the clip arm is closed by the clip tightening ring, the living tissue can be ligated with a stronger force.

  FIG. 23 shows a fourteenth embodiment, and (a) to (d) are modified examples of the holes 21 provided in the base end portions 3 a and 9 a of the clips 3 and 9. FIG. 4A shows a long hole slit. The length of the long hole is about 0.5 to 1.5 mm, and the height is about 0.2 to 0.7 mm. FIG. 2B shows a case where a round hole is provided in the middle part of the long hole slit. The length of the long hole is about 0.5 to 1.5 mm, the height is about 0.2 to 0.6 mm, and the diameter of the round hole is larger than the height of the long hole and is about 0.3 to 0.7 mm. FIG. 3C shows a cross slit. The length of the cross-shaped slit is about 0.5 to 1.5 mm, the height is about 0.3 to 0.7 mm, and the width of the slit is about 0.15 to 0.4 mm. FIG. 4D shows a case where four projecting pieces are provided from the inner periphery to the center of the round hole. The diameter of the round hole is about 0.4 to 0.7 mm, and the height of the protruding piece is about 0.15 to 0.3 mm. In the case of only a round hole, the bulge part contacts the entire circumference of the round hole, so a large amount of force may be required to deform the hole, and a strong force is required for the doctor or caregiver to perform clip ligation. Met. In the case of the hole shapes shown in FIGS. 5A to 5D, the portion deformed easily when the bulging portion comes into contact is deformed with an appropriate amount of force that is not too strong. Clip ligation can be performed.

  FIG. 24 shows a fifteenth embodiment, and (a) to (e) are modified examples of the bulging portion provided at the distal end portion of the operation wire 10. FIG. 2A shows a flat bulge 10b formed by crushing the tip of the operation wire 10 into a flat shape. The flat bulging portion 10b is necessarily larger than the hole at the base end portion of the clip, has a width of about 0.4 to 1 mm, a thickness of about 0.2 to 0.7 mm, and a length of about 0.3 to 3 mm. FIG. 2B shows a bulging portion formed by fitting a pipe-like member 10 c to the distal end portion of the operation wire 10. The pipe-shaped member 10c is fitted by welding or adhesion. The diameter of the bulging portion is necessarily larger than the hole at the base end portion of the clip, and is about 0.25 to 1 mm, and the length of the bulging portion is about 0.25 to 3 mm. FIG. 3C shows the bulging portion 10d formed by crimping the tip of the operation wire 10 into a conical shape. The diameter of the bulging portion 10d is always larger than the hole at the base end portion of the clip, and is about 0.25 to 1 mm, and the length of the bulging portion 10d is about 0.25 to 3 mm. FIG. 4D shows a bulged portion 10e formed by heating the tip of the operation wire 10 into a spherical shape. The diameter of the bulging part 10e is necessarily larger than the hole of the clip base end part, and is about 0.25 to 1 mm. FIG. 4E shows a bulging portion 10f formed by bending the distal end portion of the operation wire 10 back. The diameter of the operation wire is always larger than the hole at the base end of the clip when bent at about 0.15 to 1 mm. Further, the length of the folded portion of the bulging portion 10f is about 0.5 to 3 mm. The formation of the bulging portion shown in FIGS. 9A to 9E is simple and can reduce the cost. Further, in (b), it is easy to control the size of the bulging portion, and the amount of ligation force can be stabilized.

According to each of the embodiments, the following configuration is obtained.
(Supplementary Note 1) An introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, and a clamping portion that is provided at the distal end of an arm portion that has a proximal end portion and extends from the proximal end portion A clip device for living tissue comprising a clip in which a distal end portion of the operation wire is directly engaged with the base end portion without an engaging part interposed therebetween. When a force is applied in a direction to engage the distal end of the tube and separate the proximal end of the clip and the distal end of the operation wire, the proximal end of the clip or the distal end of the operation wire A clip device for living tissue, wherein at least one of the provided engaging means is deformed to release the engagement between the clip and the operation wire.

  (Supplementary note 2) A clip device for living tissue according to supplementary note 1, wherein a deformable ridge projecting in a direction opposite to the arm portion is provided at a proximal end portion of the clip.

  (Supplementary note 3) The biological tissue clip device according to supplementary note 1, wherein a closed loop portion is provided at a distal end portion of the operation wire.

  (Supplementary note 4) In Supplementary note 3, when the clip is engaged with the distal end portion of the introduction tube and a force in a direction separating the clip proximal end portion and the distal end portion of the operation wire is applied, the loop portion breaks, A clip device for living tissue, wherein the operation wire is disengaged.

  (Additional remark 5) In additional remark 1, it comprised the hole provided in the base end part of the clip which can penetrate the front-end | tip part of an operation wire, and the bulging part larger than the hole provided in the front-end | tip part of an operation wire, Clip device for living tissue.

  (Appendix 6) An introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, and a clamping portion that has a proximal end portion and extends from the proximal end portion And has a spreadability, and a clip in which the distal end portion of the operation wire is directly engaged with the base end portion without an engaging part, and an arm portion of the clip is fitted and attached. Provided on at least one of the clip clamping ring that closes the clip clamping part and the introduction pipe or the clamping ring, and engages the introduction pipe and the clamping ring when the clip and the clamping ring protrude forward of the introduction pipe. And a clip device for living tissue comprising an engaging means for prohibiting the fastening ring from being stored again in the introduction tube, wherein the clip engages with the distal end portion of the introduction tube, and the proximal end portion of the clip And force in the direction of pulling away the tip of the operation wire When applied, at least one of the engagement means provided in at least one of the base end portion of the clip or the distal end portion of the operation wire is deformed, and the engagement between the clip and the operation wire is released. Clip device for living tissue.

  (Supplementary note 7) The biological tissue clip device according to supplementary note 6, wherein a deformable ridge projecting in a direction opposite to the arm portion is provided at a proximal end portion of the clip.

  (Additional remark 8) The clip apparatus of the biological tissue characterized by providing the closed loop part in the front-end | tip part of the operation wire in Additional remark 6.

  (Supplementary note 9) In Supplementary note 8, when the clip is engaged with the distal end portion of the introduction tube and a force in a direction separating the clip proximal end portion and the distal end portion of the operation wire is applied, the loop portion is broken, A clip device for living tissue, wherein the operation wire is disengaged.

  (Additional remark 10) In additional remark 6, the hole provided in the base end part of the clip which can penetrate the front-end | tip part of an operation wire, and the bulging part larger than a hole provided in the front-end | tip part of an operation wire are characterized by the above-mentioned. Clip device for living tissue.

  (Additional remark 11) It has an introduction tube which can be inserted into the living body cavity, an operation member which is inserted into the introduction tube so as to be movable forward and backward, an operation wire which is inserted into the operation member so as to be movable forward and backward, and a proximal end portion A clip that has a spreadability by forming a clamping portion at the distal end of the arm portion extending from the proximal end portion, and is directly engaged with the distal end portion of the operation wire without an engaging part, and the arm portion of the clip In a biological tissue clip device, wherein the clip is operated by closing the clip clamping portion by being fitted on the clip, and the base end portion includes a clip clamping ring that can be engaged with the distal end portion of the operation member. When a force is applied to engage the distal end of the member and separate the proximal end of the clip from the distal end of the operation wire, the force is applied to at least one of the proximal end of the clip or the distal end of the operation wire. At least one of the engaging means Shape to the clip and the operating wire clipping device of the biological tissue, characterized in that to release the engagement of the.

  (Supplementary note 12) The biological tissue clipping device according to supplementary note 11, wherein a deformable ridge projecting in a direction opposite to the arm portion is provided at a proximal end portion of the clip.

  (Supplementary note 13) The biological tissue clip device according to supplementary note 11, wherein a closed loop portion is provided at a distal end portion of the operation wire.

  (Additional remark 14) In additional remark 11, when a clip engages with the front-end | tip part of an operation member and the force of the direction which separates the base end part of a clip and the front-end | tip part of an operation wire is applied, a loop part will fracture | rupture, A clip device for living tissue, wherein the engagement of the operating wire is released.

  (Supplementary note 15) In the supplementary note 11, it is characterized in that a hole provided in a clip base end portion through which a distal end portion of an operation wire can be inserted and a flat bulge portion provided in a distal end portion of the operation wire and larger than the hole are configured. Clip device for living tissue.

  (Supplementary Note 16) In a stranded wire in which at least two strands are twisted together, at least one of the strands is used to form a loop at the tip of the stranded wire, A stranded wire that has been twisted back to the proximal side of the stranded wire again.

  (Supplementary note 17) A stranded wire according to supplementary note 16, wherein the strand is constituted by a stranded wire.

  (Supplementary note 18) A stranded wire characterized in that in the supplementary note 16, three strands are twisted together to form a stranded wire.

  (Supplementary Note 19) In the biological tissue clip device according to any one of Supplementary notes 1 to 4, 6 to 9, and 11 to 14, at least one of strands of a stranded wire in which at least two strands are twisted together Using the book, a loop is formed at the tip of the stranded wire, and the operation wire or the engagement means is configured by a stranded wire in which the strand forming the loop is twisted back into the stranded wire again. Clip device for living tissue.

  (Supplementary note 20) The clip device for living tissue according to supplementary notes 1 and 6, wherein the distal end portion of the operation wire is bent and a loop portion is provided.

  (Supplementary note 21) An introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, and a clamping portion that has a proximal end portion and extends from the proximal end portion In the living tissue clip device comprising a clip formed with a clip, a hole through which the operation wire can be inserted is provided in the proximal end portion of the clip, and the distal end portion of the operation wire inserted into the hole in the proximal end portion of the clip is provided. A clip device for living tissue, wherein a bulge portion larger than a hole is provided.

  (Additional remark 22) In additional remark 21, it attaches to the arm part of a clip, is attached to the clip clamping ring which closes the clamping part of a clip, and the introduction pipe arrange | positioned behind this clip clamping ring. A clip device for living tissue, comprising an operation member inserted in such a manner as to freely advance and retreat.

  (Supplementary note 23) In Supplementary note 21, it is provided on at least one of a clip clamping ring that closes a clip clamping part and an introduction tube or a clip clamping ring by fitting and attaching to an arm part of a clip. An engagement means for engaging the clip tightening ring when the clip and the clip tightening ring protrude forward of the introduction pipe, and prohibiting the clip tightening ring from being stored again in the introduction pipe; and the clip tightening ring A living tissue clip device, comprising: an operation member that is inserted into an introduction tube disposed rearward of the tube so as to freely advance and retract.

  (Supplementary note 24) The biological tissue clip device according to any one of supplementary notes 21 to 23, wherein the distal end portion of the operation wire is flattened to form a bulge portion.

  (Supplementary note 25) The biological tissue clip device according to any one of supplementary notes 21 to 23, wherein a bulge portion is formed by fitting a pipe-like member to a distal end portion of an operation wire.

  (Supplementary Note 26) An introduction tube that can be inserted into a living body cavity, an operation wire that is inserted into the introduction tube so as to be able to advance and retreat, and a clamping portion that has a proximal end portion and extends from the proximal end portion And a clip device for living tissue comprising at least two or more clips formed with a plurality of clips arranged in series and a hole through which the operation wire can be inserted at the base end of each clip. A clip device for living tissue, characterized in that a bulge portion larger than the hole is provided at the distal end portion of the operation wire inserted through the hole at the base end portion of each clip.

  (Supplementary note 27) In supplementary note 26, the clip clamping ring that closes the clip clamping part and the clip clamping ring located at the most proximal position by being fitted and attached to the arm part of the clip are arranged behind the clip clamping ring. A living tissue clip device comprising: an operation member inserted into the introduction tube so as to freely advance and retract.

  (Additional remark 28) In additional remark 26, it is provided in at least one of a clip clamping ring which closes a clip clamping part by fitting and attaching to an arm part of a clip, and an introduction pipe or a clip clamping ring, An engaging means for engaging the clip tightening ring when the clip and the clip tightening ring protrude forward of the introduction pipe and prohibiting the clip tightening ring from being stored again in the introduction pipe; A living tissue clip device, comprising: an operation member that is inserted into an introduction tube disposed behind the clip tightening ring to be freely advanced and retracted.

  (Supplementary note 29) The biological tissue clip device according to any one of supplementary notes 26 to 28, wherein the distal end portion of the operation wire is flattened to form a bulge portion.

  (Supplementary note 30) The biological tissue clip device according to any one of supplementary notes 26 to 28, wherein a pipe-like member is fitted to the distal end portion of the operation wire to form a bulging portion.

BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is a longitudinal side view of a distal end portion of a living tissue clip device showing a first embodiment of the present invention. The longitudinal cross-sectional side view of the state which showed the same embodiment and protruded the clip. The vertical side view of the state which showed the same embodiment and clamped the biological tissue with the clip. The side view of the state which showed the same embodiment and the clip was detained in the biological tissue. The clip of the same embodiment is shown, (a) is a top view, (b) is a side view, (c) is a figure seen from arrow A direction. The side view of the operation wire which shows the same embodiment. The side view of the operation wire which shows 2nd Embodiment of this invention. The same embodiment is shown, (a)-(j) is explanatory drawing which shows the manufacturing method of an operation wire. The top view and side view of a clip and operation wire which show 3rd Embodiment of this invention. The longitudinal side view of the front-end | tip part in the clipping apparatus of the biological tissue which shows 4th Embodiment of this invention. The 5th Embodiment of this invention is shown, (a) is a side view of a clip, (b) is the perspective view. The 6th Embodiment of this invention is shown, (a) is the vertical side view of a clip apparatus, (b) is the figure seen from the arrow B direction, (c) is the figure seen from the arrow C direction. The longitudinal section side view of the state where the clip of the embodiment was detained in living tissue. The perspective view of the clip fastening ring of the embodiment. The vertical side view of the clip apparatus of 7th Embodiment of this invention. The vertical side view of the clip apparatus of 8th Embodiment of this invention. The side view of the operation wire of the embodiment. The 9th Embodiment of this invention is shown, (a)-(d) is a vertical side view which shows the effect | action of a clip apparatus. The 10th Embodiment of this invention is shown, (a)-(c) is a vertical side view which shows the effect | action of a clip apparatus. The 11th Embodiment of this invention is shown, (a)-(c) is a vertical side view which shows the effect | action of a clip apparatus. The 12th Embodiment of this invention is shown, (a)-(d) is a vertical side view which shows the effect | action of a clip apparatus. The 13th Embodiment of this invention is shown, (a)-(c) is a vertical side view which shows the effect | action of a clip apparatus. The 14th Embodiment of this invention is shown, (a)-(d) is a front view of the modification of the hole provided in the base end part of a clip. The 15th Embodiment of this invention is shown, (a)-(e) is the front view and side view of a modification of a bulging part.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Introduction pipe, 9 ... Clip, 10 ... Operation wire, swelling part 10a ... swelling part 11b ... arm part, 21 ... hole.

Claims (2)

An introduction tube that can be inserted into the body cavity;
An operation wire inserted into the introduction tube so as to freely advance and retract,
A clip that can be loaded into the introduction tube and has a base end portion and a clamping portion formed by a plurality of arm portions that extend from the base end portion and are elastically biased in a direction of expanding. When,
A wire loop portion provided at a distal end portion of the operation wire, and directly hooked and engaged with a proximal end portion of the clip without any other engagement component;
An engaging portion that is provided on the arm portion and is engageable with the leading end of the introducing tube when the arm portion protrudes from the leading end of the introducing tube and expands;
It has
The loop wire forming the wire loop portion is formed to be thinner than the thickness of the proximal end side wire forming the portion of the operation wire positioned on the proximal end side with respect to the wire loop portion, and the introduction tube and the operation By applying a force in the direction of separating the clip and the operation wire to the operation wire by moving the wire relatively forward and backward, the wire loop portion is broken and the engagement with the clip is released. A biological tissue clip device.   The biological tissue clip device according to claim 1, wherein the proximal-side wire includes a plurality of stranded wires, the core wire of the stranded wire is extended, and the extended core wire is used as the loop wire. .

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